Form .9 W
(Rev. January 2003) Department of the Treasuy Internal RevenueService
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Request for Taxpayer Identification Number and Certification
Give form to the requester. Do not send to the IRS.
Name
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Business name. if different fiom above
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02
Check
appropriate
box:
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Individuall
Sole proprietor
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Corporation
o
Partnership
0
Other ~
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Exempt from backup withholding
Address (number. street. and apt. ()('suite no.) City. state. and ZIP code List account number(s) here (optional}
Requester's
name and address (optionaO
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'er Identification Number (TIN)
Enter your TIN in the appropriate box. For individuals. this is your social security number (SSN). However. for a resident alien. sole proprietor. or disregarded entity. see the Part I instructions on page 3. For other entities. it is your employer identification number (EIN).If you do not have a number. see How to get a TIN on page 3. Note: If the account is in more than one name. see the chart on page 4 for guidelines on whose number to enter.
~
or
Certification
Under penalties of peljury. I certify that: 1. 2. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me). and I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service ORS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and I am a U.S. person (including a U.S. resident arlel1).
3.
Certification
instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently su~ect to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property. cancellation of debt contributions to an individual retirement arrangement (IRA). and generally. payments other than interest and dividends. you are not required to sign the Certification, but you must provide your correct TIN. (See the instructions on page 4.)
Sign Here
Signatureof U.S.person ~
Date~ Nonresident alien who becomes a resident alien. Generally.only a nonresident alien indMdualmay use the terms of a tax treaty to reduce or eliminate U.S. tax on certain types of income. However,most tax treaties contain a provisionknown as a ftsavingclause." Exceptions specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the recipient has otherwise become a U:S. resident alien for tax purposes. If you are a U.S. resident';~lienwho is relyingon an e)Cception contained in the saving clause of a tax treaty to claim an exemption from U.S. tax on certain types of income, you must attach a statement that specifies the followingfive items: 1. The treaty country. Generally,this must be the same treaty under which you claimed exemption from tax as a nonresident alien. 2. The treaty article addressing the income. 3. The article number (or location)in the tax treaty that contains the saving clause and its exceptions. 4. The type and amount of income that qualifies for the exemption from tax. 5. Sufficientfacts to justify the exemption from tax under the terms of the treaty article.
Form
Purpose of Form
A person who is required to file an information return with the IRS. must obtain your correct taxpayer identification number (TIN)to report, for example, income paid to you, real estate transactions, mortgage interest you paid. acquisition or abandonment of secured property, cancellation of debt. or contributions you made to an IRA. U.S. person. Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN to the person requesting It (the requester) and, when applicable, to: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withholding, or 3, Claim exemption from backup withholding if you are a U.S. exempt payee. Note: If a requester gives you a form other than Form W-9 to request your TIN, you must use the requester's form if it is substantially similar to this Form W-9. Foreign person. If you are a foreign person, use the appropriate Form W-8 (see Pub. 515, Withholding of Tax on Nonresident Aliens and Foreign Entities).
Cat. No. 10231X
W-9 (Rev. 1-20(3)